PreHospital

It was back in 2001 that I read a piece in the British Medical Journal entitled “BMJ bans accidents” – hardly a new idea (it dates back to at least 1993) – yet we still hear reference to “road traffic accidents” (RTAs) or “motor vehicle accidents” (MVAs).

Words are important; I have been convinced of the BMJ argument for the past decade. I am not alone – others say “if you care, use the term crash“. The premise is simple – use of the term “accident” implies a sense that bad outcomes are due to fate or luck, rather than factors within our control. Indeed use of the term “accident” almost absolves anyone of culpability.

I am currently working in the prehospital environment. Like colleagues, I do not judge my patients – they are invariably critically unwell and my job is simple – to ensure they receive the best possible care with the minimum of delay, working within a well-governed organisation of trained clinical professionals.

However Christmas and New Year are fast approaching, and there is a sense of inevitability; namely that this holiday season will again be marred by tragedy on our roads, often due to drink- or drug-driving.

What would be the best Christmas gift for colleagues and myself this year?

That we did not have to respond to roadside primaries, nor for community members to experience personal tragedy.

With this in mind, I’d recommend the following video – a montage of road safety videos from the TAC in Victoria, Australia (ironically, this stands for Transport Accident Commission)

It is sobering stuff. I remember hearing trauma surgeon Karim Brohi talk at the Australian Trauma Society conference in Melbourne, 2006 – he commented that “it’s better to be the fence at the top of the cliff, rather than the ambulance at the bottom“.

In trauma medicine we tend to get very excited about the sexy things – prehospital REBOA, clamshell thoracotomy, helicopters etc and debate is always heated on chestnuts such as subclavian vs IO access, fluid resuscitation, skill mix of retrieval teams etc.

There is no doubt that the downstream consequences of trauma are horrific.

Instead I wonder if the greatest gains in trauma medicine are actually to be found with the unsexy – with primary prevention (um, that’s the GPs) and with rehabilitation (thats rehab physicians, physiotherapists and other allied health).

We don’t often consider the contributions from primary care and rehabilitation in trauma care – perhaps we should.

Tim Leeuwenburg

RESUSCITATE - DIFFERENTIATE - INVESTIGATE

I am a Rural Doctor on Kangaroo Island, South Australia with interests in emergency medicine, anaesthetics & trauma. When not working I enjoy fiddling with chainsaws and seakayaking. Along with partner Patricia we rehabilitate orphaned wildlife and devise roadkill recipes.